Customer Service Representative Sr (OneCare) (Bilingual Required)

Customer Service Representative Sr (OneCare) (Bilingual Required)

CalOptima Health is seeking a highly motivated Customer Service Representative Sr (OneCare) (Bilingual Required) to join our team. The Customer Service Rep Sr (OneCare) will serve as a senior point of contact for OneCare members and providers and assist them with questions and / or complaints related to the OneCare plan services. The incumbent will provide information regarding eligibility, enrollment, benefits and services to OneCare eligible members and providers.

Position Information :

Department : CS - OneCare Customer Service

Salary Grade : 302 - $49,754 - $69,655 ($23.92 - $33.4880)

Position Type : Part Time (Up to 20-25 Hours Per Week)

Work Arrangement : Full Telework

This position is eligible for telework in California.

Duties & Responsibilities :

95% - Program Support

Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.

Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals / authorizations for medical care in-person or telephonically.

Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).

Supports in the coordination of member's health care and social service needs both within and outside the medical group and CalOptima Health.

Enters accurate and complete documentation into internal application systems regarding all concerns and / or inquiries from the member and provider interaction.

Initiates referrals to both internal and external care management departments and other department / government or community agencies.

Maintains departmental productivity and quality standards.

Follows through and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.

5% - Other

Completes other projects and duties as assigned.

Minimum Qualifications :

High school diploma or equivalent PLUS 2 years of experience in customer / member service, including 1 year of call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Typing speed of 35 words per minute (WPM) required.

Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese) required.

Preferred Qualifications :

1 year of Health Maintenance Organization (HMO), Medi-Cal / Medicaid and health services experience.

Required Licensure / Certifications :

N / A

Knowledge & Abilities :

Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.

Work independently and exercise sound judgment.

Communicate clearly and concisely, both orally and in writing.

Work a flexible schedule; available to participate in evening and weekend events.

Organize, be analytical, problem-solve and possess project management skills.

Work in a fast-paced environment and in an efficient manner.

Manage multiple projects and identify opportunities for internal and external collaboration.

Motivate and lead multi-program teams and external committees / coalitions.

Utilize computer and appropriate software (e.g., Microsoft Office : Word, Outlook, Excel, PowerPoint) and job specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations) :

Ability to visually read information from computer screens, forms and other printed materials and information.

Ability to speak (enunciate) clearly in conversation and general communication.

Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions.

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

Lifting and moving objects, patients and / or equipment 10 to 25 pounds

Work Environment :

If located at the 500, 505 Building or a remote work location :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

There are no harmful environmental conditions present for this job.

The noise level in this work environment is usually moderate.

If located at PACE :

Work is typically indoors in a clinical setting serving the frail and elderly.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

If located in the Community :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

Employee will occasionally work outdoors in varied temperatures.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

About CalOptima Health :

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options :

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical / vision / dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre / post-tax contribution options.

Important Application Information and Instructions :

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 15, 2025 at 9 : 00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences